Labor and childbirth care for women deprived of liberty: a scoping review

A scoping review, developed in accordance with JBI methodology, whose information sources were accessed in databases and gray literature. Selection was carried out between October and December 2023, based on reading titles, abstracts and descriptors, considering the following eligibility criteria: articles, dissertations and theses with different methodological designs available in full, without language and time limitations. Analysis was conducted by two independent reviewers, using inductive content analysis.

Results:

Fifteen studies were included. From the synthesis of results, two categories emerged: From the cell to the delivery room: care for women deprived of liberty; Experiences of women deprived of liberty during labor and childbirth.

Conclusion:

This study highlights the fragility of care practices during labor and childbirth, imposing significant challenges and resulting in adverse experiences that compromise the quality of motherhood and violate women’s fundamental rights.

DESCRIPTORS
Pregnant Women; Pregnant Women; Labor, Obstetric; Parturition; Prisons

MEDLINE/PubMed

((“Pregnant Women”[Mesh] OR (Pregnant Woman) OR (Woman, Pregnant) OR (Women, Pregnant) OR “Pregnancy”[Mesh] OR (Pregnancies) OR (Gestation)) AND (“Labor, Obstetric”[Mesh] OR (Obstetric Labor) OR “Delivery, Obstetric”[Mesh] OR (Deliveries, Obstetric) OR (Obstetric Deliveries) OR (Obstetric Delivery) OR “Parturition”[Mesh] OR (Parturitions) OR (Birth) OR (Births) OR (Childbirth) OR (Childbirths))) AND (“Prisons”[Mesh] OR (Prison) OR (Penitentiaries) OR (Penitentiary) OR “Prisoners”[Mesh] OR (Prisoner) OR (Hostages) OR (Hostage) OR “Correctional Facilities”[Mesh] OR (Correctional Facility) OR (Facilities, Correctional) OR (Facility, Correctional) OR (Penal Institutions) OR (Institution, Penal) OR (Institutions, Penal) OR (Penal Institution) OR (Correctional Institutions) OR (Correctional Institution) OR (Institution, Correctional) OR (Institutions, Correctional))

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Tatyanne Maria Pereira de Oliveira, Rua Dr. Epifánio Carvalho, 1391, Ininga, 64048-550, Teresina, PI, Brazil, tatyanneoliveira@ufpi.edu.br

Authorship/journal/country and year	Title	Objective	Research design/sample number	Care with labor and childbirth
Abbott et al.(²¹21. Abbott L, Scott T, Thomas H. Experiences of midwifery care in English prisons. Birth. 2023;50(1):244–51. doi: http://doi.org/10.1111/birt.12692. PubMed PMID: 36370038. https://doi.org/10.1111/birt.12692... ). Birth, United Kingdom/2023	Experiences of midwifery care in English prisons	Examine the experiences and perceptions of obstetric care for pregnant women in detention and custodial staff in English prisons.	Qualitative study (ethnography)/28 women	– No choice of partner was given for childbirth and birth; – There was no choice of obstetric care provider or place of birth; – Both women and staff demonstrated a lack of awareness of the rights a pregnant woman should receive.
Kramer et al.(²²22. Kramer C, Thomas K, Patil A, Hayes CM, Sufrin CB. Shackling and pregnancy care policies in US prisons and jails. Matern Child Health J. 2023;27(1):186–96. doi: http://doi.org/10.1007/s10995-022-03526-y. PubMed PMID: 36372806. https://doi.org/10.1007/s10995-022-03526... ). Matern Child Health J. United States/2023	Shackling and pregnancy care policies in US prisons and jails	Assess pregnancy policies and practices in prisons and jails with an emphasis on the use of restraints and compliance with anti-shackling legislation.	Qualitative study/28 units	– Restraints were used during pregnancy and post-partum, including during transport; – Significant isolation for most women giving birth in custody; – Did not require that the officers present during the childbirth be female.
Cavanagh et al.(²³23. Cavanagh A, Shamsheri T, Shen K, Gaber J, Liauw J, Vanstone M, et al. Lived experiences of pregnancy and prison through a reproductive justice lens: a qualitative meta-synthesis. Soc Sci Med. 2022;307:115179. doi: http://doi.org/10.1016/j.socscimed.2022.115179. PubMed PMID: 35809528. https://doi.org/10.1016/j.socscimed.2022... ). Soc Sci Med. Canada/2022	Lived experiences of pregnancy and prison through a reproductive justice lens: A qualitative meta-synthesis	Better understand how incarcerated people experience pregnancy and how their experiences are represented in research.	Systematic review (metasynthesis)/31 articles	– Labor and birth were traumatic for many women, exacerbated by the intersection of prison policies and clinical practices that disregarded their bodily autonomy and their role as mothers; – One participant described being scheduled and transported to the hospital to give birth without knowing what would happen.
Dalenogare et al.(²⁴24. Dalenogare G, Vieira LB, Maffacciolli R, Riquinho DL, Coelho DF. Pertencimentos sociais e vulnerabilidades em experiências de parto e gestação na prisão. Cien Saude Colet. 2022;27(1):263–72. doi: http://doi.org/10.1590/1413-81232022271.33922020. PubMed PMID: 35043905. https://doi.org/10.1590/1413-81232022271... ). Ciên Saúde Colet. Brazil/2022	Pertencimentos sociais e vulnerabilidades em experie^ncias de parto e gestac¸a~o na prisa~o	Understand the pregnancy and childbirth experiences of women in prison.	Qualitative study/seven women	– Labor was perceived as painful and distressing, due to the degrading state of the care offered from the removal from the prison unit to the health institution; – In the penitentiary, labor progresses with the help of professionals from the Prison Basic Health Unit; – During the night or on weekends, the decision to refer women to the health institution is made by security agents; – Absence of companions of women’s choosing and, often, without being able to inform them about the situation, they are accompanied by security agents; – Use of shackles on the way from the prison to the health institution; – The treatment offered by the health institution staff is perceived in different ways by women. Some praised it, while others reported being treated with indifference, neglect and violence; – Inattention to good practices related to childbirth, with the use of interventionist measures to speed it up.
Kirubarajan et al.(²⁵25. Kirubarajan A, Tsang J, Dong S, Hui J, Sreeram P, Mohmand Z, et al. Pregnancy and childbirth during incarceration: a qualitative systematic review of lived experiences. BJOG. 2022;129(9):1460–72. doi: http://doi.org/10.1111/1471-0528.17137. PubMed PMID: 35274810. https://doi.org/10.1111/1471-0528.17137... ). BJOG-Int J Obstet Gy. Canada/2022	Pregnancy and childbirth during incarceration: A qualitative systematic review of lived experiences	Characterize patients’ experiences of pregnancy and childbirth during incarceration through qualitative synthesis.	Systematic review (metasynthesis)/24 articles	– Use of restraints during pregnancy and childbirth; – Lack of emotional support; – Trauma of separation from the newborn after birth.
Fortunato et al.(²⁶26. Fortunato LMH,Meira LG,Silveira CP,Rabelo EM,Takeshita IM. Percepção das mulheres privadas de liberdade sobre a assistência à saúde recebida no pré-natal, parto e puerpério: revisão integrativa. REAS. 2022;15(2):e9558. doi: http://doi.org/10.25248/reas.e9558.2022. https://doi.org/10.25248/reas.e9558.2022... ). REAS. Brazil/2022	Percepção das mulheres privadas de liberdade sobre a assistência à saúde recebida no pré-natal, parto e puerpério: revisão integrativa	Describe, from the perspective of women deprived of liberty, how healthcare occurs during pregnancy, childbirth and the puerperium.	Integrative review/15 articles	– Delay in referral to maternity; – Family members are not informed of the start of labor and, when notified, they are unable to arrive in time to accompany women; – The police escort does not make contact with the family, and these women rarely receive visits while still in the maternity ward; – Women highlighted violence, mainly in verbal and psychological forms, in addition to invasive procedures, physical aggression and negligence, lack of humanization and guidance during care; – There are reports of the use of shackles during childbirth and hospitalization.
Suarez(²⁷27. Suarez A. “I wish i could hold your hand”: inconsistent interactions between pregnant women and prison officers. J Correct Health Care. 2021;27(1):23–9. doi: http://doi.org/10.1089/jchc.19.06.0048. PubMed PMID: 34232769. https://doi.org/10.1089/jchc.19.06.0048... ). Correct Health Care. United States/2021	“I Wish I Could Hold Your Hand”: Inconsistent Interactions Between Pregnant Women and Prison Officers	Explore women’s interactions with prison officers during pregnancy, labor and childbirth.	Qualitative study/18 women	– Rude officers in the unit during transports and even in the delivery room; – General lack of privacy and acknowledgement that they were giving birth; – Police officers were sometimes nosy or too talkative or ignored women in labor who were often in pain.
Abbott et al.(²⁸28. Abbott L, Scott T, Thomas H, Weston K. Pregnancy and childbirth in English prisons: institutional ignominy and the pains of imprisonment. Sociol Health Illn. 2020;42(3):660–75. doi: http://doi.org/10.1111/1467-9566.13052. PubMed PMID: 31922273. https://doi.org/10.1111/1467-9566.13052... ). Sociol Health Illn. United Kingdom/2020	Pregnancy and childbirth in English prisons: institutional ignominy and the pains of imprisonment	Explore the experiences of pregnant women in prison through qualitative interviews with a sample of female detainees, another sample of prison staff, and field observations.	Qualitative study (ethnography)/28 women	– Loss of privacy compounded the loss of dignity and decency; – The environment was considered so hostile to spontaneous labor that it seemed unsafe to engage in labor in prison.
Johnston(²⁹29. Johnston H. Imprisoned mothers in Victorian England, 1853–1900: motherhood, identity and the convict prison. Criminol Crim Justice. 2019;19(2):215–31. doi: http://doi.org/10.1177/1748895818757833. https://doi.org/10.1177/1748895818757833... ). Criminol Crim Justice. United Kingdom/2019	Imprisoned mothers in Victorian England, 1853–1900: Motherhood, identity and the convict prison	Explore the experiences of mothers incarcerated in the Victorian convict prison system.	Qualitative study (life story)/288 women	– Pregnant women when arrested or convicted gave birth in local prisons.
Matos et al.(³⁰30. Matos KKC, Silva SPC, Nascimento EA. Filhos do cárcere: representações sociais de mulheres sobre parir na prisão. Interface (Maynooth). 2019;23:e180028. doi: http://doi.org/10.1590/interface.180028. https://doi.org/10.1590/interface.180028... ). Interface. Brazil/2019	Filhos do cárcere: representac¸o~es sociais de mulheres sobre parir na prisa~o	Understand the social representations of incarcerated pregnant and postpartum women about giving birth in prison.	Qualitative study/19 women	– Only prison officers are present when the time comes to give birth and they are taken to the hospital; – Perceive the judgment that was made, denoting the prejudice of other postpartum women, companions and healthcare professionals towards them.
Leal et al.(³¹31. Leal MC, Ayres BVS, Esteves-Pereira AP, Sánchez AR, Larouzé B. Nascer na prisão: gestação e parto atrás das grades no Brasil. Cien Saude Colet. 2016;21(7):2061–70. doi: http://doi.org/10.1590/1413-81232015217.02592016. https://doi.org/10.1590/1413-81232015217... ). Ciên Saúde Colet. Brazil/2016	Nascimento na prisão: gravidez e nascimento atrás das grades no Brasil	Outline the profile of the female incarcerated population living with their children in women’s prisons in the capitals and metropolitan regions of Brazil as well as the conditions and practices related to care during pregnancy and childbirth during incarceration.	Quantitative study/241 mothers	– The presence of companions of women’s choice during hospitalization for childbirth was 3%; – Postpartum women reported having suffered mistreatment or violence during their stay in maternity wards by healthcare professionals (16%) and by guards or prison officers (14%); – The use of shackles at some point during hospitalization for childbirth was reported by 36% of pregnant women, with 8% reporting having been put shackles even during childbirth; – Only 10% and 11% of women reported having their privacy respected by healthcare professionals and prison guards/officers, respectively. This percentage was slightly higher when the topic was healthcare professionals’ treatment towards them (18%).
Spinola(³²32. Spinola PF. A experiência da maternidade no cárcere: cotidiano e trajetórias de vida [dissertação]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2016. p. 12 [cited 2024 Aug 8]. Available from: https://www.teses.usp.br/teses/disponiveis/5/5170/tde-11052017-140243/publico/Priscilla FeresSpinola.pdf. https://www.teses.usp.br/teses/disponive... ). Faculdade de Medicina da USP. Brazil/2016	A experiência da maternidade no cárcere: cotidiano e trajetórias de vida	Know and understand the experience of motherhood in prison based on the daily lives and life trajectories of women released from the penitentiary system.	Qualitative study (hermeneutics)/two women	– Compliance with all bureaucratic procedures (signatures, magazines) and then being sent to the hospital; – The condition of being taken to the hospital only occurred when a child was about to be born; – Use of hand and foot cuffs during labor and childbirth; – Feeling of pain and no proper communication; – Description of difficult childbirth.
Ferszt and Clarke(³³33. Ferszt GG, Clarke JG. Health care of pregnant women in U.S. state prisons. J Health Care Poor Underserved. 2012;23(2):557–69. doi: http://doi.org/10.1353/hpu.2012.0048. PubMed PMID: 22643607. https://doi.org/10.1353/hpu.2012.0048... ). J Health Care Poor Underserved. United States/2012	Health care of pregnant women in U.S. state prisons	Examine healthcare practices for pregnant women in state prisons.	Mixed-methods study/32 prisons	– Use of abdominal chains/belts, leg shackles, and shackles when transporting women to a hospital or clinic; – Restraint during labor and even during the birth of a baby; – Restraint during immediate recovery period and in hospital rooms.
Rosinski et al.(³⁴34. Rosinski TC, Cordeiro CG, Monticelli M, Santos EKA. Nascimento atrás das grades: uma prática de cuidado direcionada a gestantes, puérperas e recém-nascidos em privação de liberdade. Cienc Cuid Saúde. 2006;5(2):211–9. doi: http://doi.org/10.4025/ciencuidsaude.v5i2.5077. https://doi.org/10.4025/ciencuidsaude.v5... ) Ciênc., Cuid. Saúde. Brazil/2006	Nascimento atra´s das grades: uma pra´tica de cuidado direcionada a gestantes, pue´rperas e rece´m-nascidos em privac¸a~o de liberdade	Develop a care practice aimed at pregnant women, postpartum women and newborns deprived of liberty, guided by Orem’s General Nursing Theory.	Qualitative study/12 women	– Use of shackles during labor and childbirth that made it impossible to hold the baby; – Lack of contact with a child.
Amnesty International(³⁵35. Amnesty International. Pregnant and imprisoned in the United States. Birth. 2000;27(4):266–71. doi: http://doi.org/10.1046/j.1523-536x.2000.00266.x. PubMed PMID: 11251513. https://doi.org/10.1046/j.1523-536x.2000... ). Birth. United States/2000	Pregnant and imprisoned in the United States	Describe human rights violations of pregnant women and mothers incarcerated in prisons and jails in the United States.	Qualitative study/-	– Pregnant women were restrained when transported to the hospital and kept under restraints while in the hospital, even while at labor, unless a doctor ordered their removal and a correctional officer approved; – Women were put shackles even in the presence of a prison guard or, in some cases, shackles were removed up to 30 minutes before childbirth; – Lack of permission to move around during labor; – Some women reported that, after birth, they remained with the baby for a while, but, shortly afterwards, the police replaced the shackles to remove the baby from the delivery room.